Is It Safe to Mix Tadalafil (Cialis) and Alcohol?

Tadalafil, known by the brand name Cialis, treats erectile dysfunction. It can also address the symptoms of an enlarged prostate. How long it stays active in the body leads some to believe it is permissible to drink after taking this drug.

So, can you mix tadalafil (Cialis)and alcohol?

The safety of mixing tadalafil with alcohol depends on how much alcohol you consume and your overall health. Most healthy persons suffer no adverse effects to low amounts of alcohol consumption. However, heavy alcohol consumption while using tadalafil can lead to dangerous side effects like dizziness, rapid heart rate, fainting, and low blood pressure.

Clinical studies and the FDA’s Cialis prescribing information have looked into this effect. This is what we know.

How Does Tadalafil (Cialis)Work?

Tadalafil is a member of the pharmaceutical family of PDE5 inhibitors.

It facilitates an erection by relaxing the blood vessels of the penis to allow for increased blood flow in a sexually stimulated state.

Tadalafil can lead to blood pressure decreasing because of the blood vessel relaxation. Alcohol also has temporary blood pressure lowering effects and is particularly concerned with higher dosages.

Together, tadalafil and alcohol have additive  effects with systemic vasodilation.

What Happens When You Mix Tadalafil (Cialis) and Alcohol?

The primary concern is a further drop in blood pressure.

According to the FDA, tadalafil and alcohol are both mild systemic vasodilators. Some clinical pharmacology studies have documented cases of patients experiencing clinically significant reductions in blood pressure, including postural dizziness and orthostatic hypotension, after taking tadalafil in the presence of moderate to high quantities of alcohol.

Orthostatic hypotension occurs when blood pressure decreases when you stand up. Symptoms of orthostatic hypotension may include:

• Dizziness
• Lightheadedness
• Weakness
• Blurred vision
• Fainting

The symptoms are especially pronounced when there is rapid alcohol consumption and/or large volume alcohol consumption.

What Does the Research Say?

There is an evident clinical tadalafil-alcohol interaction.

In FDA reviewed studies, subjects were administered relatively large amounts of alcohol along with tadalafil. For the first two studies, alcohol was administered at the dose of 0.7 g/kg, which is the equivalent to 6 oz of 80 proof vodka for an 80 kg man administered over a 10 minute period. Some subjects reported clinically significant orthostatic hypotension and blood pressure reductions.

Results, however, were not consistent across all studies.

When 20 mg of tadalafil was administered along with a lower amount of alcohol at 0.6 g/kg, no cases of orthostatic hypotension were reported, while dizziness was reported at the same frequency as with alcohol alone. Tadalafil does not alter blood alcohol concentrations, and alcohol does not affect the concentration of tadalafil in the blood. The FDA labelling reported these findings.

This indicates that the quantity and rapidity of alcohol administration is important.

Can Tadalafil (Cialis)and Alcohol Cause Low Blood Pressure?

Yes.

While tadalafil (Cialis) on  its own has only minor effects on blood pressure, clinical data on more than 4,000 subjects found that, in most cases, changes in blood pressure were of a minor nature and were not considered clinically significant.

When consumed in higher quantities, tadalafil and alcohol can have significant negative effects and can even lead to symptoms such as dizziness.

Because of the FDA data, we know that the combination can lead to a greater blood pressure drop, especially under some drinking conditions.

Is One Drink with Tadalafil Dangerous?

For healthy individuals, having a small amount of alcohol would most likely not cause significant issues, however, having a lot of alcohol is still a considerable risk, even without tadalafil.

There is increased risk if you are:

• Drink several alcoholic beverages
• Low blood pressure
• Take blood pressure medication
• Take alpha blocker
• Have cardiovascular disease
• Dehydrated
• Have fainted

The best safe practice is to avoid a significant amount of alcohol while tadalafil is active.

Why Heavy Drinking Is More Concerning

Even without tadalafil (Cialis) drinking a considerable amount of alcohol has several negative impacts on balance, judgment and blood pressure, etc., and all of these effects could be made worse by tadalafil.

Heavy drinking also makes it more difficult to achieve and sustain an erection. This goes against the purpose of taking tadalafil.

Therefore, taking more tadalafil to address alcohol-related sexual difficulties is an unsafe strategy.

What About Tadalafil’s Longer Lasting Effects?

An important difference of tadalafil from some other erectile dysfunction medications is the longer period of time it can be effective for.

Tadalafil’s terminal half-life is around 17.5 hours, so the effects can last significantly longer than most PDE5 inhibitors.

This means that the effects of both tadalafil and the alcohol can overlap even if you do not drink right after taking the medication.

This is especially concerning with daily tadalafil since the medication is active in the body continuously.

Who Should Be Especially Careful?

There are instances where people need to use caution when using alcohol and tadalafil.

There are certain medical conditions and some medications where the safety of use with alcohol and tadalafil needs to be addressed.

Nitrate Medications

Obviously, using tadalafil (Cialis) and nitrate medications should be avoided since the combination can cause symptoms of a severe drop in blood pressure.

Alpha Blockers

There is also the risk of tadalafil when used with alpha-blockers that can be used to manage high blood pressure or urinary issues associated with an enlarged prostate.

According to clinical studies, tadalafil enhances the blood-pressure-lowering effect of some alpha-blockers.

Blood Pressure Medicines

Individuals on antihypertensive medications should ask their physician on the safety and effectiveness of coadministration with tadalafil.

Tips for Drinking Alcohol While Taking Tadalafil

The following may help to minimize risk when taking tadalafil (Cialis):

• Avoid binge drinking
• Spread out drinking several drinks over a period of time
• Drink plenty of water
• Don’t take additional tadalafil due to decreased sexual performance.
• If you’re dizzy, stand up slowly
• Do not drive if tadalafil makes you dizzy.

If you have severe dizziness, fainting, chest pain, or other frightening symptoms, call 911 or ambulance.

Final Thoughts

Mixing tadalafil (Cialis) with alcohol does not pose an immediate threat to most people, but with heavy alcohol intake the risk of low blood pressure and fainting does increase. The FDA has clinical studies that show a greater amount of blood-pressure lowering effects from tadalafil and greater alcohol intake.

Tadalafil (Cialis) users must practice moderation. If you have heart disease, low blood pressure, take nitrates or alpha-blockers, or drink heavily on a regular basis, discuss alcohol and tadalafil (Cialis) with your health care professional.

References

• U.S. FDA — Cialis (tadalafil) prescribing information.
• U.S. FDA — Clinical pharmacology review of tadalafil and alcohol.
• Kloner R, et al. Cardiovascular effects of tadalafil. American Journal of Cardiology.
• PubMed — Clinical studies examining tadalafil and cardiovascular effects.